Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico.
M.D./Ph.D. (PECEM), Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico, Mexico.
J Nucl Cardiol. 2023 Jun;30(3):1219-1229. doi: 10.1007/s12350-022-03136-9. Epub 2022 Nov 8.
Three-vessel disease (3VD) is a cardiovascular disorder that affects the three main coronary arteries. Gated myocardial perfusion SPECT (GMPS) evaluates ventricular function, synchrony, and myocardial perfusion. However, the diagnostic performance of GMPS parameters to assess 3VD has not been fully explored.
To assess the univariate performance capacity of GMPS parameters, and to evaluate whether phase parameters could provide additional predictive value for the detection of patients with 3VD compared to control subjects.
We designed paired retrospective samples of GMPS images of patients with 3VD (stenosis > 70% of left anterior descending, right coronary, and circumflex coronary arteries) and without 3VD. A GMPS in rest-stress protocol was performed using 99mTc-Sestamibi and thallium and analyzed with the 3D method. Area under the receiver-operating characteristic curves (AUROC), decision curve analyses and diagnostic test performance were obtained for univariable analyses and stepwise binomial logistic regression for multivariable performance.
474 Patients were included: 237 with 3VD (84% males, mean age 61.7 ± 9.9 years) and 237 with normal GMPS (51% women, mean age 63.8 ± 10.6 years). The highest AUROC for perfusion parameters were recorded for SSS, SRS and TID. For dyssynchrony parameters, both entropy and bandwidth in rest and stress phases displayed the highest AUROC and diagnostic capacity to detect 3VD. A multivariate model with SRS ≥ 4, SDS ≥ 2, TID > 1.19 and sBW ≥ 48° displayed the highest diagnostic capacity (0.923 [95% CI 0.897-0.923]) to detect 3VD.
Perfusion and dyssynchrony were the parameters which were most able to discriminate patients with 3VD from those who did not have CAD.
三血管病变（3VD）是一种影响三支主要冠状动脉的心血管疾病。门控心肌灌注 SPECT（GMPS）评估心室功能、同步性和心肌灌注。然而，GMPS 参数评估 3VD 的诊断性能尚未得到充分探讨。
评估 GMPS 参数的单变量性能能力，并评估相位参数是否可以为检测 3VD 患者提供比对照组更多的预测价值。
我们设计了配对的 GMPS 图像回顾性样本，包括 3VD（狭窄>70%的左前降支、右冠状动脉和回旋支冠状动脉）患者和无 3VD 患者。使用 99mTc-Sestamibi 和铊进行 GMPS 静息-应激方案，并使用 3D 方法进行分析。获得单变量分析的受试者工作特征曲线（AUROC）下面积、决策曲线分析和诊断测试性能，以及多变量性能的逐步二项逻辑回归。
共纳入 474 例患者：237 例 3VD（84%男性，平均年龄 61.7±9.9 岁）和 237 例 GMPS 正常（51%女性，平均年龄 63.8±10.6 岁）。灌注参数的最高 AUROC 记录为 SSS、SRS 和 TID。对于同步性参数，静息和应激期的熵和带宽均显示出最高的 AUROC 和诊断能力，以检测 3VD。一个包含 SRS≥4、SDS≥2、TID>1.19 和 sBW≥48°的多变量模型显示了检测 3VD 的最高诊断能力（0.923[95%CI 0.897-0.923]）。
灌注和同步性是最能区分 3VD 患者和非 CAD 患者的参数。
